Home > Autism, Disability Rights, Psychology, Psychology, Philosophy, and Other Deep Thoughts > Open Letter to ABA Folks: On the Word “No.”

Open Letter to ABA Folks: On the Word “No.”

If you have not done so, please read the introduction to this letter series before continuing: https://restlesshands42.wordpress.com/2014/09/27/an-open-letter-to-aba-folks-intro/

Overview of this letter:

Section 1: About the word “no” and why it is important

Section 2: Observed ABA practices in teaching “no” and why they are problematic

Section 3: Brief recap of section 2

Section 4: Practical suggestions for addressing these issues in ABA sessions

***

Section 1: About the word “no” and why it is important

“NO.” It’s one of our most powerful words. It’s one of the first words children learn that isn’t a noun. The “No!” phase, also known as the “Terrible Two’s,” is a critical part of human psychological development. In learning to voice a refusal, toddlers learn a huge amount about the world and themselves. They learn that they are individuals, with desires and preferences that are not always the same as those of their caregivers. They learn that they are able to express this difference of opinion in a way that others understand. And most critically they learn that, by voicing this opinion, they sometimes have the ability to change what happens to them. Anyone who’s ever had a toddler knows that sometimes they just say “no” to everything, out of sheer joy at having the power to refuse.

A major feature of autism is a difference in the way autistic and non-autistic people learn to communicate. Autistic children often take much longer than their non-autistic peers to develop speech or other formal communication methods (such as sign-language, PECS, or an electronic device).

Autism therapy often focuses on developing the ability to indicate the word “no,” for good reasons. Children who can’t use some recognizable form of “no” are a lot less happy than those who can tell their caregivers when they dislike something (a food, a place, an activity, etc.). Also, given no other means to express “no,” most children will eventually resort to tantrums or violence as a means of indicating displeasure. This can be physically and emotionally dangerous for both caregiver and child.

***

Section 2: Observed ABA practices in teaching “no” and why they are problematic

Ok, I assume you didn’t really need any convincing on those points. Now, let’s talk about how ABA teaches “no.” I’d like you to imagine a scenario for me. The vast majority of ABA folks are neurotypical (non-autistic), so I assume none of you have any difficulties with imagining.

Let’s say you’ve moved to another country, one whose language is particularly difficult for you to learn and use. Perhaps it has very different speech sounds than your native language, or another mode of communication entirely (humming through your nose, for example, or doing complicated dance steps).

So someone, or a group of people, is assigned to teach you the basic phrases and words you need to know in this language. The way they decide to teach you “No” (or maybe “stop”) is the following:

You’re stuck in a room with them, and they do things to you that you hate. They pinch you, or drag their nails down a chalkboard, or grab your personal belongings away from you, and they keep doing this until you say “no” to their satisfaction. Even if it’s perfectly clear what you’re trying to say, if you pronounce it just a little bit wrong, or stumble on one of those dance steps, they ignore you until you get it right. Sometimes, you did get it right, but they’re busy making notes or talking to someone else, and you have to do it again.

When you do get it right, they pat you on the head, say “good job,” and let you do something pleasant for a few minutes. Then they start up again. If you put your hands over your ears to block that horrible screeching noise, they hold your hands down. If you try to object in your own language, your objection is ignored. If you get fed up and scream or burst into tears or punch someone (and who wouldn’t, after enough of this?), or even just sit down on the floor and refuse to participate any longer, you get marked down for misbehaving. Maybe, if they’re nice and sensible, they start giving you longer breaks or do something that you don’t hate quite as much. Not much of a consolation, is it?

So maybe, yes, you will learn to say “no” in this new language. Maybe you’ll even learn it faster, in self-defense, than you would have otherwise. But what will you think about the people teaching you? Will you respect them, or just fear them? More importantly, will you believe that they respect you?

In addition, imagine that you’re a child, with little experience of the world. Your own beloved parents tell you that these teachers are here to help you, that you should obey them and try to please them. They call you their “friend,” and unless someone has already explained otherwise, you probably get it into your head that friends are people who are allowed to push you around like this.

(How many of you had a friend or sibling who took advantage of your trust or your admiration when you were little? They made you do something you hated, or got you in trouble for something they did, or tormented you in some other way… Do you remember how much it hurt? I do.)

You might even start thinking there’s something wrong with you. After all, these people are trying to help you, right? They like you and care about you and are experts. So maybe there’s something wrong with YOU for hating the lessons so much. You wonder if you’re too sensitive, too slow a learner, or just a bad person who isn’t worthy of more respect and kindness.

(I’m sure you remember feeling that way sometimes, too).

Or you start thinking it’s ok to make other people miserable, and treat your own friends this way. And then you probably get labeled “aggressive” or “antisocial” and get taken our of you classroom to go have more therapy.

***

Section 3: Brief recap of section 2

If all that made your head spin, let’s simplify it.

Can ABA therapy teach a kid how to say “no”? Sure.

Is it the fastest way? Maybe.

Is it worth the emotional frustration, destruction of trust, mixed messages about what “teaching” and “helping” and “caring” mean, and possible long-term hostility that can result? You tell me.

***

Section 4: Practical suggestions for addressing these issues in ABA sessions

OK, criticism only goes so far. I’m not here to make you feel bad; I’m here to help your jobs better. The following are my suggestions for teaching “no” or “stop” via ABA with minimal trauma.

1) Don’t do too much in one day. 1-3 trials per session, no more. Seriously. It may take longer, but it’s worth the wait. You can tell parents they are much less likely to see tantrums, aggression, and meltdowns after sessions if this is done slowly. (Technical note: whatever stimulus you use to elicit a “no” behavior is also going to be perceived as a punishment for whatever the child’s antecedent behavior was. Less technically, if you keep doing something a child hates, they’re going to wonder what they did first to make you do that to them. This can mess up other aspects of the session.)

2) Don’t give praise or additional reinforcement (rewards). The best, in fact the ONLY valid reinforcement for saying “no” is to have the other person respect that request. Don’t say “good job,” because expressing your needs isn’t a job or a task, it’s an essential human activity. Don’t make it less meaningful by assigning it the same status as answering an informational question correctly. I DO encourage you to (sincerely!) apologize to the child for doing something they disliked, or say something like “thank you for letting me know that you want me to stop” (especially if the word is replacing violent behavior!)

3) As soon as the child has a response that is recognizable as “no,” respect it. Respect it whenever possible. If it can’t be respected in a given instance, verbally acknowledge it (“I understand that you don’t like ____” — this also helps clarify the referent of the “no”) and explain why you are not going to stop just yet, or why they have to do the thing they don’t want to despite protesting (you’d do this with a typical child, right? Stop thinking of your clients as that different. They have plenty of typical thoughts and feelings– they just don’t express them the same way others do). You can use “no” as an opportunity for further engagement– offer alternatives for the child to pick (“Would you rather we did ___?”), or bargain with them (e.g. “We can stop in five minutes if you keep working with me right now”). Encourage the family to do this too, especially respecting the use of “no” as much as possible. This is crucial to maintenance. “No” will only become a true part of a child’s functional vocabulary if it is generally effective in eliciting negative reinforcement (i.e., it gets the child the result they are requesting).

4) If you need to shape the physical pronunciation of “no,” “stop,” and similar terms, do that later, separately, and via DTT that is reinforced by something utterly neutral to the situation. Don’t make correct pronunciation a high-stakes task. Again, less technically: if the child needs to say “no,” more clearly, have them practice mimicking your speech (with a bunch of words, ideally), in a game-like setting where they win stickers or candy or tokens for better pronunciation. That lets them practice saying the word more clearly without having to worry that their objections will be ignored if they aren’t performed perfectly.

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  1. PK
    September 29, 2014 at 7:25 am

    May I link to this segment (and other ABA links you’re doing in this chain) in a linkedin discussion I’m participating in? There’s a person there who is pretty rabid about ABA because “The CDC, CMS, and AHRQ among many others note ABA as the most effective behavior treatment for individuals with autism.” and “Clinical guidelines are created to set standards. The consequence of deviating from those standards are ultimately paid by the individual who should rely on professionals to adhere to them.” and “The AHRQ offers rigorous scrutiny, and outlines the efficacy of ABA (see Table B): http://effectivehealthcare.ahrq.gov/ehc/products/544/1945/autism-update-report-140806.pdf ( DIDN”T READ THE ATTACHMENT) –

    She has a business (www.autism-u.com) that she makes money on (not that it’s a bad thing), but it’s like talking to a brick wall trying to have a disucssion with this person about the pitfalls.

    I don’t want to link to your stuff without asking because the last thing I want is someone like this giving you grief. But the others in the conversation would benefit from linking to your commentary.

    Thanks!

    Liked by 1 person

  2. Restless Hands
    October 2, 2014 at 3:01 pm

    Please do link her! In addition to this letter series, I link her to this post: https://restlesshands42.wordpress.com/2014/06/04/interconnectedness-science-aba-and-autism/

    I’m very interesting in getting more serious critical dialogue started about ABA. It seems to me that so many of the autistic self-advocacy crowd have been too emotionally traumatized by personal experiences with ABA to discuss it calmly, and so many of the pro-ABA people have careers or even more emotional things at stake that prevent them from being able to approach concerns about ABA with an open mind.

    Other good resources for ABA critiques are:
    http://jack-not-jacque.tumblr.com/post/48645978990/so-you-want-to-work-with-autistic-kids-primer
    The comments here: https://www.facebook.com/ParentingAutisticChildrenWithLoveAcceptance/posts/692941684077047
    http://karlamclaren.com/research-based-approaches-to-autistic-ways-of-learning/
    https://www.facebook.com/groups/339196629475913/files/
    https://www.facebook.com/notes/parenting-autistic-children-with-love-acceptance/compliancesocial-skills-aba-indistinguishability-resources/661982837172932

    Sorry for the massive amount of linkage!

    Like

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